Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 31217 | WI |
NPI | 1033109541 |
---|---|
Provider Name | Anthony M Jarrett |
First Address | Eau Claire, WI 54702-1510 |
Second Address | La Crosse, WI 54601-8806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 15/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E48355 | (02) |